HIPOTIROIDISME (Chintya)

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HIPOTIROIDISME
Hipotiroid adalah defisiensi aktifitas tiroid, salah satu sebab
kreatinisme pada anak dan miksedema pada dewasa, ditandai dgn
penurunan laju metabolisme, keletihan dan latergi. (DORLAND)
• Hypothyroidism is a clinical syndrome resulting from a deficiency of
thyroid hormones, which in turn results in a generalized slowing down
of metabolic processes.
• infants and children results in ; slowing of growth and development. with
serious permanent consequences, including mental retardation, when it occurs
in infancy.
• adulthood causes a generalized decrease in metabolism, with slowed heart
rate, diminished oxygen consumption, and deposition of glycosaminoglycans in
intracellular spaces, particularly in skin and muscle, producing in extreme cases
the clinical picture of myxedema. (reversible with theraphy)
EPIDEMIOLOGI
• Kelainan fungsi tiroid terbanyak
• Insidens 1:3000-5000 kelahiran
• Pada bayi dan anak-anak berakibat perlambatan pertumbuhan dan
perkembangan
• Pada usia dewasa menyebabkan perlambatan umum organisme
dengan deposisi glikoaminoglikan pada rongga intraseluler (otot dan
kulit)
• Wanita 2x > sering
INSIDENSI
• Hashimoto’s thyroiditis is by far the most common cause of hypothyroidism. In
younger patients, it is more likely to be associated with goiter; in older patients, the
gland may be totally destroyed by the immunologic process, and the only trace of
the disease is a persistently positive test for TPO antibodies.
• the end stage of Graves’ disease may be hypothyroidism, occurring spontaneously
or following destructive therapy with radioactive iodine or thyroidectomy.
• susceptible to excessive iodide intake (eg,ingestion of kelp tablets, iodide-containing
cough preparations,or the antiarrhythmic drug amiodarone) or intravenous
administration of iodide-containing radiographic contrast media. Wolff-Chaikoff
effect
• the late phase of subacute thyroiditis or silent thyroiditis; this is usually transient,
but it may be permanent especially in silent thyroiditis, where permanent
hypothyroidism occurs in about 25% of patients.
• Iodide deficiency is not a cause of hypothyroidism in the United States, but it is still frequently seen
in developing countries.
• drugs can block hormone synthesis and produce hypothyroidism with goiter; at present, the most
common pharmacologic causes of hypothyroidism (other than iodide) are te, used for the treatment
of bipolar disease, and amiodarone. Chronic therapy with the antithyroid drugs PTU and methimazole
have the same effects. Interferonalfa, used to treat hepatitis C and other conditions can cause altered
immunity that can result in hypothyroidism due to Hashimoto’s thyroiditis.
• thyroid dyshormonogenesis,result from genetic deficiencies in enzymes necessary for hormone
biosynthesis. These effects may be complete, resulting in a syndrome of cretinism with goiter; or
partial, resulting in goiter with mild hypothyroidism.
• At least five separate biosynthetic abnormalities have been reported:
• (1) impaired transport of iodine;
• (2) deficient peroxidase with impaired oxidation of iodide to iodine and failure to incorporate iodine
• into thyroglobulin;
• (3) impaired coupling of iodinated tyrosines to triiodothyronine or tetraiodothyronine;
• (4) absence or deficiency of iodotyrosine deiodinase, so that iodine is not conserved within the gland;
• (5) excessive production of metabolically inactive iodoprotein by the thyroid gland
ETIOLOGI
Secara klinis dikenal 3 hipotiroidisme, yaitu :
• 1. Hipotiroidisme sentral, karena kerusakan hipofisis atau
hypothalamus
• 2. Hipotiroidisme primer apabila yang rusak kelenjar tiroid
• 3. Karena sebab lain, seperti farmakologis, defisiensi yodium,
kelebihan yodium, dan resistensi perifer.
• classified as (berdasarkan penyebab)
• primary (thyroid failure) (by far the most
common),
• secondary (due to pituitary TSH deficiency),
• tertiary (due to hypothalamic deficiency of
TRH)
• peripheral resistance to the action of
thyroid hormones.
• TERSIER
• SEKUNDER
• PRIMER
can also be classified as
• goitrous
• nongoitrous,
but this classification is probably unsatisfactory, because Hashimoto’s thyroiditis (autoimmune thyroiditis) may
produce hypothyroidism with or without goiter.
Manifestasi klinik
• Kreatisnisme
• bayi/anak awal
• wilayah endemi defisiensi yodium dari makanan ;Himalaya,Cina darataan,Afrika.
• Kelainan metrabolisme bawaan(mis, def enzim ) yg menganggu biosint TH (kreatinisme
sproradik)
• Gx; , gg perkm tulang,saraf pusat, retardasi mental berat, pendek, wajah kasar, lidah
menonjol, hernia umbilikalis.
DIAGNOSIS
• The combination of a low serum FT4 and an elevated serum TSH is diagnostic
of primary hypothyroidism
• Hashimoto’s thyroiditis, which can be confirmed by assessing anti-TPO
antibody titers.
• secondary or “central” hypothyroidism, the serum FT4 will be low and serum
TSH will be low or normal, rather than elevated.
TATALAKSANA
• Tujuan pengobatan :
a. Meringankan keluhan dan gejala
b. Menormalkan metabolisme
c. Menormalkan TSH
d. Membuat T3 dan T4 normal
e. Menghindari komplikasi dan resiko
TATALAKSANA
• Terapi sulih hormone tiroid secara bertahap dengan preparat sintetik
T4(levotiroksin) dan kadang-kadang dengan T3
Dosis : 1,6mcg/kgBB/hari(total 100-150mcg/hari)
-pasien <60th tanpa peny. Jantung dan pd  dosis renda ( 50mcg/hari_
-peningkatan dosis dilakukan secara perlahan apabila belum
mencapai batas normal. Penambahan 12.5mcg/hari setiap 2bln+cek
kadar TSH
• Pembedahan eksisi, kemoterapi, atau radiasi jika terdapat tumor pada
organ yang terkena
Edukasi
• Tekankan kepatuhan. Sifat hipotiroidisme seumur hidup, kebutuhan
terapi levothyroxine seumur hidup, cara yg tepat untuk minum obat,
dan kebutuhan untuk pengujian TSH min setiap tahun.
• Pasien menggunakan hormone tiroid sbg dosis harian tunggal. Banyak
obat dpt mengganggu penyerapan dan tidak boleh dikonsumsi dlm 2-
4 jam setelah pemberian LT4
• Kontrasepsi oral esterogen/progestin & kehamilan berhub dgn
perubahan globulin pengikat tiroid. Perubahan ini dpt mempengaruhi
dosis hormone tiroid.
KOMPLIKASI
• Koma miksedema situasi yang mengancam jiwa yang ditandaidengan

eksaserbasi (perburukann semua gejala hipotiroidisme, termasuk
hipotermi tanpa menggigil, hipotensi, hipoglikemia, hipoventilasi,
dan penurunan kesadaran yang menyebabkan koma.
PROGNOSIS
• Hipotiroidisme yg tdk diobati dpt menyebabkan koma dlm atau
kematian.
• Pada bayi  keterbelakangan mental yg ireversibel
• Pasien dgn gagal jantung memiliki prognosis yg lbh buruk.
Thank you
Bahan bacaan
• Greenspan
• http://jurnal.fk.unand.ac.id/index.php/jka/article/viewFile/674/539
• Patologi Robbins
• Infodantin www.depkes.go.id/download.php?file=download/pusdatin/infodatin/infodatin...pdf
• https://www.sciencedirect.com/topics/veterinary-science-and-veterinary-medicine/cretinism
• HARRISON ED 13
• Hole, Human Anatomy & physiology, 10th ed

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• Koma miksedema situasi yang mengancam jiwa yang ditandaidengan

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